What is the primary goal of therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy?

• A. To increase cerebral metabolism to hasten recovery
• B. To promote systemic vasoconstriction
• C. To enhance inflammatory response
• D. To limit brain injury by reducing metabolic demand and neuronal injury

Answer: (D)

Therapeutic hypothermia protects the brain by slowing cellular activity, which lowers the brain’s demand for oxygen and energy after a hypoxic-ischemic event. By cooling to about 33–34°C for roughly 72 hours, neurons require less ATP, reducing energy failure and the subsequent cascade that leads to further injury. This dampens processes like excessive glutamate release, calcium overload, free radical formation, inflammation, and programmed cell death, helping to limit the extent of brain injury and improve outcomes. It’s started early, within several hours after birth, and followed by careful gradual rewarming. The other ideas describe effects that cooling is not primarily aiming for—raising metabolism, promoting vasoconstriction, or boosting inflammation—whereas the main goal is to minimize neuronal damage by reducing metabolic demand and injury.